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Salary: USD 100,000 - 130,000 / annual
ERGO NEXT is a technology-led, full-stack provider of small business insurance, transforming the customer experience for entrepreneurs across the United States. Since 2016, the company has helped hundreds of thousands of small business customers get fast, customized, and affordable coverage.
As a Claims Specialist, you will serve as a subject matter expert in the Claims department, handling high-severity and high-complexity commercial claims. You will lead department roundtables and serve as a valuable peer resource to other team members.
Key responsibilities include:
- Extensive policy document and legal contract interpretation
- Analyze and identify coverage and related coverage issues
- Manage, investigate, and resolve claims within prescribed authority levels
- Recommend ultimate resolution on assigned cases exceeding your authority to claims management
- Leverage deep litigation handling experience in General Liability and Casualty files
- Drive litigation, attend mediations, trials, and alternative dispute resolution proceedings
- Communicate with policyholders, witnesses, and claimants to gather information and advise on proper courses of action
- Respond to written and telephone inquiries, including status reports
- Present file materials for authority and roundtables
- Collaborate with nurses, doctors, and attorneys on file reviews
- Ensure compliance with all statutory and regulatory requirements across applicable jurisdictions
- Meet quality assurance standards and performance goals
- Set and revise case reserves in accordance with reserving policy
- Identify suspicious claims and refer to Special Investigation Unit (SIU); identify third-party subrogation opportunities
- Maintain security of financial processing and claims file information
- Work with and provide guidance to independent field adjusters
- Partner with internal teams and advise leadership on key claim activities and exposures
Requirements:
- Bachelor's degree (BS/BA) required
- Advanced studies or insurance designation preferred
- At least 10+ years of directly related experience with Commercial General Liability and Litigation
- Strong written and oral communication skills; strong interpersonal, analytical, investigative, and negotiation skills
- In-depth knowledge of multi-jurisdictional claims handling issues
- Willingness to utilize and adapt to evolving technologies within claims operations
- Self-starter capable of working independently
- Must have or be able to promptly obtain a Texas Independent Adjuster License
- Proven success delivering strong results in a rapidly changing claims environment
- High degree of comfort navigating ambiguous environments
- Receptivity to feedback and willingness to learn new software systems
- Some travel capability, up to approximately 10%
